Private medical insurance (PMI) covers expenses incurred in the private treatment of acute (short-term, curable) illnesses and injuries.
Apart from specific exclusions, the following are generally not covered:
- Pre-existing conditions (except on “moratorium” policies)
- Chronic (i.e. incurable) illnesses
- Conditions brought about through drug abuse, self-inflicted injuries, war risks and hazardous pursuits
- Treatment for HIV/AIDS, infertility and normal pregnancy; sex change (“gender reassignment”), cosmetic surgery, organ transplant, kidney dialysis and experimental treatment and drugs
- GP services, accident & emergency admissions, outpatient drugs and dressings and mobility aids.
Kinds of Private Health Insurance Policies
Policies essentially differ by their premium levels and the breadth of their cover. A standard policy excludes all ailments suffered before the commencement of the current contract, known as “pre-existing conditions”.
Pre-existing conditions can often be barriers to changing insurers, because a new insurer will want to exclude them from the cover either permanently or temporarily.
Moratorium policies cover pre-existing conditions but only after a specified treatment-free period has elapsed (e.g. 2 years), starting from when the policy is first taken out. The definition of “treatment-free” can be strict, but usually means that during the moratorium period:
* There have been no consultations with a doctor concerning the pre-existing or any related condition
* No advice has been sought about the condition, including check-ups.
* No medication or special diets have been prescribed.
Moratorium policies are often criticised on the grounds that they may encourage policyholders to defer necessary medical treatment in order to have the costs met by the insurer.
Benefits and Exclusions
- Inpatient Treatment All policies fully cover a common core of inpatient costs for accommodation (“hotel costs”); surgeons, anaesthetists & physicians; drugs and dressings, operating theatres, radiotherapy & chemotherapy, specialist consultations, diagnostic procedures (radiology, pathology etc), physiotherapy and prothesis. Psychiatric treatment and pregnancy complications are the most common exclusions
- Outpatient Treatment and Additionals “Comprehensive” policies will cover the costs of most (but not all) outpatient treatment and other “additional” expenses such as home nursing or private ambulance transport. “Budget” policies sometimes (but not universally) exclude outpatient treatment altogether.
By and large, you get the cover that you pay for although policies within the same premium range do not necessarily offer the same breadth of the cover.
To get advice from an independent health care specialist call 0800 043 0725 or visit www.yourlocalifa.co.uk to find a financial adviser